Donald Trump meets with Paul Ryan at the U.S. Capitol, November 10, 2016.

By Zach Gibson/Getty Images.

When the Congressional Budget Office released the numbers on Trumpcare—or Ryancare, or whatever you want to call the two-headed boar unveiled by Paul Ryan as a replacement to Obamacare—showing that more than 20 million Americans would join the ranks of the uninsured in a few years, what came to mind was Buck Turgidson making the case for a nuclear first strike in Dr. Strangelove. “Mr. President, I’m not saying we wouldn’t get our hair mussed,” he promises. “But I do say no more than 10 to 20 million killed, tops.” Yes, some of the people losing their coverage would be dropping it by choice, freed up by the end of individual mandates. But many others would be pushed out by a massive increase in premiums. It takes a zealot like Ryan to be “encouraged” by that kind of analysis.

This has been an amazingly speedy descent into Republican self-sabotage. Ryan’s bill is almost universally disliked. Liberals and Democrats hate it for hurting lower-income Americans. Conservatives and Republicans hate it for either hurting lower-income Americans or for not hurting them enough. (Ohio governor John Kasichcondemns the bill for reducing Medicaid coverage for the poor, while small-government Republicans like Rand Paulcall it “Obamacare Lite.”) Americans who currently subsidize Obamacare would be re-united with their money, while Americans who depend on the subsidies would be out of luck. The Ryan bill seems to promise a replay of hits from the George W. Bush years, when Republicans who preferred zero spending on the poor clashed with Republicans who preferred medium spending on the poor, but found common ground through their shared interest in big spending on the rich.

Much of this was to be expected, because Ryan is Ryan, and the G.O.P. is the G.O.P. What was up for grabs was the stance of Donald Trump. Was he going to insist on doing more to protect the little guy? Or was he going to throw his lot in with Ryan? We now see that, despite some concerns from his friends in the media, he chose the latter. (Or perhaps he chose it after Ryan incorporated some of Trump’s requests to protect the little guy—in which case Trump didn’t get very far.) Trump has been lobbying aggressively to get Ryan’s bill passed, inviting skeptics to meetings at the White House, promising rallies, and generally spending a lot of scarce political capital.

If the bill passes, many of Trump’s voters will get hurt, leaving Trump damaged. If it fails, the White House will have suffered a big defeat, leaving Trump damaged and his agenda weakened. It’s not a favorable set of choices. If nothing else, though, it will be the first big test of Trumpism. Its contradictions could be hidden during a campaign season. Now, they are coming into sharp relief.

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In theory, Trumpism follows the tradition of the European right, which combines nationalism with support for the welfare state. In practice, Trumpism relies on Donald Trump, who is many things to many people, and the Republican Party, which rejects nationalism (apart from the interventionist sort) and seeks to shrink the welfare state. Even if Trump were a resolute ideologue of the Marine Le Pen variety, he’d be stymied on all sides. Democrats, borrowing from Republicans under Obama, would still wish to undermine Trump whenever possible, even if they agreed with his aims. Republicans, who remain the party they were two years ago, albeit with a new boss, would likewise be uncooperative. The main difference between the ideological Trump and the one we have is that the latter is less sure of what he wants and therefore less predictable. But he’s still boxed in.

As a campaigner, Trump promised not only to eliminate Obamacare, but also to replace it with a scheme that would offer better health care at a lower cost to more people. If there were an obvious way to achieve this, even Trump’s enemies would sign on. In real life, though, the numbers are unforgiving. If you want to offer better coverage with lower premiums, then either Washington has to remake health-care from the ground up or it has to spend more, or both. You can’t change a few regulations about selling health insurance across state lines and expect miracles to ensue. Trump has to be Santa Claus or Scrooge, and he loses fans either way.

Trump has often been compared to the Democrat George Wallace, who ran strikingly successful populist campaigns in 1968 and 1972. If Trump were really a modern-day Wallace, however, then he wouldn’t touch Ryan’s bill. He would keep requiring the rich to pay hefty sums; Medicaid support would continue; middle-class Americans would get increased subsidies; and maybe the age of eligibility for Medicare would even get lowered to 55. In short, he’d be Santa Claus, mainly at the expense of wealthier Americans.

But Trump is, by tradition, a businessman with sympathy for other businessmen, and he doesn’t like making rich people pay more in taxes or fees. So he doesn’t go there. Even if he were to defy his own side, Trump might have a hard time finding allies on the opposite side of the aisle, because resistance to Trump among Democrats runs so deep.

So Trump is left trying to smooth over what can’t be smoothed, and even his most ardent supporters are left at a loss. Online radio host Bill Mitchell, who became famous in 2016 for a faith in Trump that would be the envy of most religions, first mused that Trump was secretly trying to undermine the bill. “If Trump’s plan in allowing Ryan to release his healthcare plan first was to have it publicly beaten the sh*t out of, it’s working,” he tweeted on March 11, following that two days later with, “If Trump wanted to kill Ryan’s Healthcare Plan, what better way than to leave it out in the sun?”

Then, one day later, Mitchell seemed to think the bill was good after all. “The ‘14 million uninsured’ are more than offset by the 100 million + who will be able to afford their insurance,” Mitchell suggested, before settling a couple of hours later with “#TrustTrump. He knows how all the pieces fit together in the end.”

Of course, Trump isn’t the only one with something at stake here. Ryan has plenty riding on this bill, too. But the rollout has been so clumsy that people wonder if Ryan even supports his own bill. Ezra Kleinsuspects that Ryan wants this effort to fail, allowing Republicans to say they tried but were blocked by Democrats. Similarly, Matt Fullerreports in the Huffington Post that Republicans will be happy just to get the bill out of the House. All of this would indicate a cynical and pathetic set of motivations, which seems in line with reality. But it’s hard to see how Ryan comes out looking anything but feckless, and he takes the president down with him. If nothing else, it could make for some memorable insults.